Exertional Dyspnea Incidentally Diagnosed as Sarcoidosis: A Teaching Hospital Experience

Abstract

Background: Sarcoidosis is a complex disease with nonspecific etiology and clinical presentation. Its diagnosis is often delayed due to the absence of a single specific investigation modality. A multidisciplinary approach is necessary for its diagnosis. Report. A 49-year-old male presented with recurrent dyspnea on exertion, easy fatigue, and chest pain after several visits to different health facilities over 5 months. A diagnosis of pulmonary sarcoidosis was made after a series of laboratory and imaging investigations were done revealing bilateral reticonodular opacifications, noncaseating granulomata, elevated serum ACE and calcium levels consistent with sarcoidosis.

Conclusion: Sarcoidosis, although a rare presentation in our setting, may easily be overlooked or misdiagnosed if a holistic or multidisciplinary approach is not employed in its diagnosis. Nonspecificity of symptoms contributes to the delayed diagnosis.

Figure 1

(a) Chest X-ray showing diffuse bilateral reticulonodular changes. (b) Chest CT scan showing diffuse bilateral reticulonodular opacities with multiple left lung calcifications and cardiomegaly with dilated pulmonary trunk.

Figure 2

(a, b) H&E ×100 shows effacement of lung tissue by multiple variably sized naked noncaseating granulomata (red arrows) with surrounding fibrosis containing lymphocytic cells. (c–d) H&E ×400 shows a high-power view of noncaseating granulomata (orange star) with multinucleate Langhans giant cells (black arrow).